Depression, functional disability, and accessing health care among older Ghanaians and South Africans: a comparative study based on WHO study on global ageing and adult health (SAGE).

OBJECTIVES: The study explored the association and variabilities between mild depression, functional disability, and healthcare access among older Ghanaians and South Africans. METHOD: The data used in this study was based on the Cross-sectional wave 1 (2007-2010) data from WHO's Study on Global Ageing and Adult Health (SAGE). Using multiple binary logistic regression, responses from a sample of 4558 Ghanaians and 3076 South Africans were analyzed to investigate hypothesized patterns. RESULTS: The proportion of mild depression (MD) is 6.0 % and 7.53% for older Ghanaians and older South Africans, respectively. At 95% Confidence Interval, increased severity (mild and high levels) of functional disability are associated with increased odds of MD in Ghanaian and South African older adults. Apart from South African older adults, older Ghanaians in the study who do not receive healthcare when needed have increased odds of MD than those who do. Sociodemographic and socioeconomic factors are also associated with MD. DISCUSSION: An untreated, persistent MD may lead to worse conditions with fatal outcomes. Since mental health care is lacking in both countries, this study may inform policies directed towards support for formal and informal long-term care, and healthcare access to reduce the risks of depression.

Marital quality, gender, and later-life depressive symptom trajectories.

We analyze six waves of data (2006-2016) from the Health and Retirement Study (n = 4,342) to examine how marital quality is associated with depressive symptom trajectories among a group of continuously married older adults. Results show gender parity in how own perceptions of positive and negative dimensions of marital quality are related to depressive symptom trajectories. In addition, spousal perceptions of negative marital quality are positively associated with growth in depressive symptomatology regardless of gender. Spousal perceptions of positive marital quality, however, are associated with lower depressive symptoms only for women.

Mistrust in Physicians does not Explain Black-white Disparities in Primary Care and Emergency Department Utilization: The Importance of Socialization During the Jim Crow era.

PURPOSE: Compared to whites, blacks under-utilize primary care (PC) and over-utilize emergency department (ED) services. The aim of this study is to determine whether mistrust in physicians explains these black-white disparities, and the potentially modifying influence of socialization under racially segregated health care (i.e., raised in the U.S. South during the Jim Crow era). METHODS: Data come from the nationally representative Americans' Changing Lives Study (n=1,578). Poisson regression techniques are utilized to respectively model PC and ED utilization among a sample of non-Hispanic black and white adults aged forty-years and older. CONCLUSION: Mistrust in physicians does not explain black-white disparities in PC or ED utilization. Blacks under-utilize PC services compared to whites, net of predisposing, need, and enabling factors, but this is especially apparent among blacks who were raised in the U.S. south during the Jim Crow era and continue to reside in the South. Blacks greatly over-utilize ED services compared to whites, but this is greatest among those raised in the south during the Jim Crow era and/or those currently residing in the South.

Does cohort matter in the association between education, health literacy and health in the USA?

Summary: Growing empirical evidence supports the generally positive relationship between education, health literacy and health outcomes. However, little is known about cohort in this relationship. This study examined the role of cohort defined by 10-year age period in the association between educational attainment, health literacy and self-rated health. The data were obtained from the 2003 National Assessment of Adult Literacy survey restricted file. Focusing on nationally representative community-dwelling adults age 25 years and older, self-rated health was modeled as a function of health literacy, educational attainment, cohorts (defined by 10-year age periods), other demographic characteristics and socio-economic status. While the youngest cohort was positively associated with self-rated health, middle-age cohorts were more likely to have lower self-rated health (compared with the age 65 years and older cohort). Interestingly, age was no longer statistically significant after adjusting for cohort and other covariates. Recognition of possible cohort effects in education, health literacy and health should be reflected in future health literacy research and intervention programs for addressing health disparities in the USA.

INITIAL EXPLORATION OF NEWLY IMPLEMENTED PUBLIC HEALTH POLICY USING GEOGRAPHIC INFORMATION SYSTEMS: THE CASE OF A U.S. SILVER ALERT PROGRAM.

CONTEXT: Public health policies are designed for specific subsets of the population. Evidence that a policy is effectively designed should be based on whether it effectively addresses its mission. A critical factor is determining whether utilization patterns reflect the mission and the efficacy of public health policies, particularly during early stages of implementation. We assert that utilization patterns can be effectively assessed using geographic information systems (GIS). OBJECTIVE: This paper uses the Silver Alert program, a recently implemented public health policy, as a case for how and why GIS can be used to examine utilization patterns. DESIGN: GIS are employed to visualize and spatially analyze a new health policy--North Carolina's Silver Alert policy. We use visualized data and spatial statistics to assess utilization patterns and mission adherence. RESULTS: Results show disproportionate utilization patterns of the Silver Alert policy. In particular, an outstanding number of Silver Alerts were used in Wake County and its surrounding counties, which are both the political and media center of North Carolina. Other counties, including populous counties, had few if any alerts. CONCLUSION: Findings suggest that the North Carolina's Silver Alert policy needs to be adjusted to more effectively address its mission. We identify several factors that need further examination prior to a statewide evaluation. From this case study, we propose ways future programs, particularly the introduction of the Affordable Care Act (ACA) in 2014, might use GIS to examine utilization patterns as a means to better understand whether and in what ways the health care needs of the public are being met with such a policy.

Marital Quality and Depressive Symptoms Among Older Hispanic Adults in the United States.

OBJECTIVES: Despite the cultural importance of marriage as a social support system and its well-established link to mental health, older Hispanic adult populations, which are the largest racial and ethnic minoritized groups, remain understudied. The current study examined how positive and negative dimensions of marital quality are associated with depressive symptoms. METHODS: Data from Hispanic adults aged 51 years and older (n = 1,012) were obtained from the 2016 and 2018 Health and Retirement Study waves. The Center for Epidemiological Studies-Depression scale (0-8 symptoms) was modeled as a function of positive and negative marital quality measures (1-4), as well as the relevant covariates. RESULTS: Results from a negative binomial regression model showed that a 1-unit change in positive and negative marital quality was associated with a 23.61% reduction and a 23.74% increase, respectively, in depressive symptoms. The interaction terms with marital quality and gender, as well as marital quality and religion, were not statistically significant. DISCUSSION: In the United States, a large percentage of older Hispanic adults are immigrants, and their extended family tends to reside in their countries of origin. As such, older Hispanic adults may have smaller social networks, and marital quality most likely represents a culturally important social support network in later life. Significant associations between depressive symptoms and marital quality among older Hispanic adults should receive more attention in family and public health policy discussions, particularly given the increasing diversity in U.S. society.

Analyzing state-based Silver Alert programs: the case of North Carolina.

BACKGROUND: Recent discussions about securing the autonomy and safety of older people in a cost-effective way have culminated in the establishment of "Silver Alert" media-alert policies in more than half of US states over the past 5 years. Although these policies have been established with exceptional legislative speed, research has not yet examined how these policies have been implemented across geographic areas. METHODS: Data from the 587 Silver Alerts activated in North Carolina in 2008, 2009, and 2010 were analyzed. Zero-inflated negative binomial regression and exploratory spatial analyses were employed. RESULTS: Despite a policy focus on older adults and individuals with cognitive impairment, activation of Silver Alerts in a county was not related to the proportion of the population 65 years of age or older or to the prevalence of poor mental health in the county. Rather, a 1-unit increase in the proportion of the population comprised of African Americans increased the rate of Silver Alert activation by a factor of 1.019 (P < 0.01). Additionally, spatial analyses suggested that the number of Silver Alerts in a county was related to its proximity to North Carolina's state capital, Raleigh. LIMITATIONS: These results should be interpreted with caution because an exploratory analytic approach was employed in both regression and spatial analyses. CONCLUSION: The current mission and implementation of the Silver Alert program should be reviewed, given that significant effects were observed for the proportion of African Americans in a county and the county's distance from the state capital, but not for the proportion of older adults in the county or for the prevalence of impaired mental status.

Self-perception of aging and perceived medical discrimination.

BACKGROUND: Individuals who perceive medical discrimination often face adverse consequences. How individuals perceive their own aging experiences may influence perceived medical discrimination due to age by generating expectations that they will receive poor treatment from clinicians, which may be amplified for individuals who also perceive discrimination because of race. This study explored the relationship between self-perceptions of aging (SPA) and perceived medical discrimination due to age, race, and other reasons. METHODS: We used three waves (2008, 2012, 2016) from the nationally representative Health and Retirement Study (HRS) data. Our sample included 10,188 community-residing individuals aged 51 and over. SPA were measured by two domains: positive SPA and negative SPA. Multinomial logistic regression that adjusted for demographic, health characteristics, and year-fixed effects was conducted to estimate the relationship between SPA and categories of perceived medical discrimination (age, race, age and race, and other). RESULTS: Approximately 11% of the population perceived discrimination because of age or race in the medical setting from 2008 to 2016. Older adults who had a positive SPA were 15% [Adjusted relative risk ratio (ARR): 0.85, 95% CI: 0.79-0.91], 13% [ARRR: 0.87, 95% CI: 0.76-1.00], and 20% [ARRR: 0.80, 95% CI: 0.74-0.88] less likely to experience perceived medical discrimination due to age, race, and the intersection of age and race, respectively, than those who did not, holding other factors constant. Those who held a negative SPA were 38% [ARRR: 1.38, 95% CI: 1.28-1.48] more likely to report perceived medical discrimination due to age and 12% [ARRR: 1.12, 95% CI: 1.03-1.21] more likely to report perceived medical discrimination due to other reasons. CONCLUSIONS: Holding a positive perception of aging may help reduce perceived medical discrimination because of age and race, which may in turn improve communication and lead to timely and appropriate treatment.

Childhood Socioeconomic Status and Physical Activity in Later Life: The Role of Perceived Neighborhood Cohesion and Wealth in Adulthood.

The literature indicates that perceived neighborhood social cohesion is related to later life physical activity. However, there is no research that examines the role of childhood socioeconomic status (SES) in shaping this relationship. We use data from the Health and Retirement Study (2006-2016; N = 8,754) and a structural equation modeling approach to examine whether perceived neighborhood social cohesion and adulthood wealth mediate the relationship between childhood SES and physical activity. Perceived neighborhood social cohesion and adulthood wealth have small but statistically significant mediational effects in the relationship between childhood SES and physical activity. Research on the relationship between health and place should consider the potential impact of childhood circumstances on the neighborhood one lives in during adulthood.

Determinants of COVID-19 testing among late middle-aged and older adults: Applying the health belief model.

Objectives: The purpose of this study was to examine correlates of taking a COVID-19 test among late middle-aged and older adults using nationally representative data. Methods: Data were obtained from the 2020 Health and Retirement Study midway release COVID-19 module. Our sample was representative of community residing adults aged 51 and over in the United States (n = 2,870). Measurements: We regressed taking a COVID-19 test on demographic characteristics, medical comorbidities, and measures related to the health belief model (i.e., perceived severity, perceived susceptibility, cues to action, and perceived barriers) using logistic regression, stratifying the model by 10-year age categories. Results: Concern about the pandemic was associated with an increase in the likelihood of taking a test among late middle-aged adults. Knowing someone who was diagnosed with COVID-19 was associated with taking a test in most age categories. Financial barriers and knowing someone who died of COVID-19 were not associated with taking a test. Conclusions: How late middle-aged and older adults perceive the COVID-19 pandemic may significantly influence their likelihood of taking a COVID-19 test.

Urban and Rural Differences in Trajectories of Depressive Symptoms in Later Life in the United States.

OBJECTIVE: This research has two primary goals: to examine the relationship between urban residence and trajectories of depressive symptoms and to investigate whether this relationship differs by social isolation and loneliness. METHOD: Data are from 2006, 2008, 2010, 2012, 2014, and 2016 waves of the Health and Retirement Study (HRS), a nationally representative sample of U.S. adults aged 51+ (n = 3,346 females and 2,441 males). We conduct latent growth curve analysis to predict both baseline and trajectories of depression based on urban or rural residency. RESULTS: Residing in urban or rural areas is neither significantly associated with baseline nor the development of late-life depressive symptoms. For females, the relationship between urban residence and baseline depressive symptoms is explained by socioeconomic factors. DISCUSSION: Findings of this study serve to better understand how social and geographic contexts shape long-term well-being of older adults.

Intergenerational Ambivalence and Loneliness in Later Life.

OBJECTIVE: This brief report examined the relationship between intergenerational ambivalence and loneliness in later life among a group of older adults with at least one child. BACKGROUND: Previous work has explored the links between intergenerational ambivalence and other indicators of well-being but has not examined loneliness. Although studies show an association between positive and negative relationship quality with children and loneliness, there are conflicting findings, and there is also insufficient exploration of the role of gender. METHOD: Utilizing pooled data from the 2012 and 2014 waves of the Health and Retirement Study (HRS) (n = 10,967) (https://hrs.isr.umich.edu/documentation), structural equation models were used to examine the hypothesized relationships, and multiple group analysis was utilized to assess potential gender differences. RESULTS: The results indicated that greater intergenerational ambivalence was associated with increased loneliness in later life. However, there were no significant gender or marital status differences in the relationships. CONCLUSION: This study adds to the existing literature on ambivalence and well-being by showing that ambivalent relationships are related to loneliness. Results underscore the emotional complexity of parent-child relationships and suggest the need for investigating the consequences of holding contradictory feelings.

Resident Preferences and CNA Empowerment: Testing Validity and Reliability of a Culture Change Survey Tool.

Culture change (CC) is an innovation to improve nursing home resident quality of life. Inconsistencies in how CC is measured make the interpretation of findings inconclusive. The purpose of this study is to determine the underlying factors of CC among Ohio nursing homes to extract the core essence of CC. Data from the 2015 Ohio Biennial Survey of Long-Term Care Facilities with n = 721 nursing homes answering a CC module comprising of 21 questions are included in an exploratory factor analysis (EFA). EFA results identified two underlying factors of CC that are extracted using principal factor method. These factors include items related to resident preferences for care (RPC) and certified nursing assistant (CNA) empowerment. This study presents two valid and reliable scales to advance the measurement of CC. These scales can be used to explore both RPC and CNA empowerment components as predictors or outcomes.

What could be influencing older Ghanaians outpatient care utilization rate?

OBJECTIVES: Ghana's population is rapidly aging and there may be healthcare access and utilization issues. This study investigates some of the issues that may influence outpatient care utilization rate among older Ghanaians. METHODS: Cross-sectional wave 1 (2007-2010) data from WHO's Study on Global Ageing and Adult Health are used, and a sample of 1408 are analyzed. After multiple imputations of missing values, a negative binomial regression model is used to identify the association between outpatient care utilization rate and lifestyle activities. RESULTS: The rate of outpatient care utilization is negatively associated with the rate of eating vegetables (ß =0.0830, p < .001), fruits (ß =0.0033, p < .05), moderate-exercise (ß =0.4010, p < .001), moderate-work (ß =0.2049, p < .001), walking/biking (ß = 0.0436, p < .001), and positively associated with leisure hours ((ß =0.0194, p < .001). CONCLUSION: To promote better aging situations of older adults in Ghana, poverty and poor education should be addressed as potential barriers to healthcare access. There is a need for policies that encourage healthier lifestyles for older Ghanaian's health. FUNDING: The study was self-funded by the authors.

Race-ethnic inequality and psychological distress: depressive symptoms from adolescence to young adulthood.

Social inequality is well established in the mental health of race-ethnic groups, but little is known about this disparity from adolescence to young adulthood. This study examined differences in trajectories of depressive symptoms across 4 race-ethnic groups (Whites, Blacks, Hispanics, and Asians) using 3 waves of the National Longitudinal Study of Adolescent Health. Latent trajectory analyses showed race-ethnic variations among both females and males. Stressors were significantly related to depressive symptoms for all study members, but they accounted for symptom trajectories only among Black males and minority females. Persistent differences in trajectories for Blacks and Whites showed parallel slopes that did not converge over time. Neither background characteristics nor social resources (i.e., social support) altered this gap. However, social support represents a potential equalizer of these race-ethnic differences, owing to the ubiquitous nature of its protective effects.

Measuring positive attitudes toward persons with dementia: A validation of the Allophilia scale.

Efforts to combat ageism typically focus on negative attitudes toward members of an out-group. Changing attitudes also requires assessment and enhancement of positive attitudes. This study examined the psychometric properties of Allophilia scale when used to measure college students' positive attitudes toward persons with dementia. Data collected from 465 students were analyzed using confirmatory factor analysis and multigroup analysis by gender to assess the validity and reliability of the Allophilia scale. Results showed that the Allophilia scale is valid both for male and female students. The Allophilia scale is a valid assessment tool for measuring positive attitudes toward persons with dementia. Use of this scale will contribute to our understanding of attitudes toward persons with dementia and has implications for the design of interventions to facilitate positive attitudes toward members of this out-group.

Marital quality, marital dissolution, and mortality risk during the later life course.

This study examines the relationship between later-life marital quality, marital dissolution, and mortality using discrete-time event history models with data from nine waves (1992-2008) of the Health and Retirement Study (n = 7388). Results show marital status is more important for men's mortality risk than women's, whereas marital quality is more important for women's survival than men's. Being widowed or divorced more than two years raises mortality risk for men, but later-life marital dissolution is not significantly associated with women's mortality risk, regardless of the type of dissolution or length of time since it occurred. Low-quality marital interaction is negatively related to women's odds of death, but none of the marital quality measures are significantly associated with mortality for men. Marital satisfaction moderates the relationship between widowhood and mortality for women, but the relationship between marital dissolution and mortality is similar for men regardless of marital quality prior to divorce/widowhood. Results suggest the importance of accounting for both marital status and marital quality when examining older individuals' mortality risk.

The Effect of altering ADL thresholds on active life expectancy estimates for older persons.

OBJECTIVES: Research on disability and active life expectancy (ALE) has often criticized the measurement of disability but has rarely empirically investigated the effect of changing measurement. The purpose of this study was to determine whether altering the number of activities of daily living (ADLs) required to consider an individual "disabled" affects population-based ALE estimates after considering parametric uncertainty and sampling error. METHODS: The authors develop a Bayesian approach to estimating multistate life tables for a three-dimensional state space, using data on community-dwelling older adults from the 1989 and 1994 National Long Term Care Survey analytic files. Empirical confidence intervals for ALE are compared across 6 models using successively higher ADL cutoffs for defining individuals as being disabled. RESULTS: After considering sampling and other errors in the estimation of transition probabilities, the authors found that altering the threshold for measuring disability has relatively little effect on ALE estimates, especially with higher ADL-level thresholds and at older ages. DISCUSSION: The implications of the results include that disability measurement, including altering the definition of being disabled and possibly expanding the state space of a model, may not affect population-based estimates of ALE.

An international comparison of the Ohio department of aging-resident satisfaction survey: applicability in a U.S. and Canadian sample.

PURPOSE OF THE STUDY: The majority of resident satisfaction surveys available for use in assisted living settings have been developed in the United States; however, empirical assessment of their measurement properties remains limited and sporadic, as does knowledge regarding their applicability for use in settings outside of the United States. This study further examines the psychometric properties of the Ohio Department of Aging-Resident Satisfaction Survey (ODA-RSS) and explores its applicability within a sample of Canadian assisted living facilities. DESIGN AND METHODS: Data were collected from 9,739 residential care facility (RCF) residents in Ohio, United States and 938 assisted-living residents in British Columbia, Canada. Confirmatory factor analysis was used to assess the instrument's psychometric properties within the 2 samples. RESULTS: Although the ODA-RSS appears well suited for assessing resident satisfaction in Ohio RCFs, it is less so in British Columbia assisted living settings. Adequate reliability and validity were observed for all 8 measurable instrument domains in the Ohio sample, but only 4 (Care and Services, Employee Relations, Employee Responsiveness, and Communications) in the British Columbia sample. IMPLICATIONS: The ODA-RSS performs best in an environment that encompasses a wide range of RCF types. In settings where greater uniformity and standardization exist, more nuanced questions may be required to detect variation between facilities. It is not sufficient to assume that rigorous development and empirical testing of a tool ensures its applicability in states or countries other than that in which it was initially developed.

Programs to locate missing and critically wandering elders: a critical review and a call for multiphasic evaluation.

As America ages, greater numbers of older adults will be living with Alzheimer's disease or a related dementia, leading to increased incidence of wandering. Currently there are several initiatives to assist older adults who go missing. We describe and critically examine three prominent and widespread programs: Safe Return, Project Lifesaver, and Silver Alert. Despite their emergence, there has been little research on their effectiveness. More fundamentally, the nature and scope of the missing elder problem is understudied. We call for further research into this issue, as well as assessments of how well such programs balance individual liberties with safety concerns.